My Mom has been diagnosed with Stage 3 breast cancer. She is 70 years old and has diabetes (around 110 fasting) and hypertension (140/70). She takes Glycomet GP-1 for diabetes and olvance H20 for Blood pressure. She had swelling in her right arm apparently due to the tumor compressing the veins. we would not have known about cancer if not for the swelling in the right arm. Doctor initially said my Mom needs to undergo neoadjuvant Chemotherapy to shrink the tumor before surgery. She is currently undergoing chemotherapy and has completed 3rd cycle of FAC regimen 2 days back. Doctor has suggested to do a 2D Echo after 3 weeks from 3rd Cycle, but there is no recommendation to do CT scan of something else to check the chemo response. She is not having much side effects at all. The Swelling has reduced a bit, but has not gone away completely. I am very worried if she is getting the right treatment. The PET CT scan says supraclavicular node positive with SUV of 10 and dimension of 19mm x 20mm. I am very worried about involvement of Supraclavicular Lymph Node. When I run my fingers over it, it moves a lot actually. Is there a chance of this being benign? I have read that cancer tumors are normally irregular, hard and immovable. Please let me know.
Here are the details of tests
1. lump in axillary tail 49mm X 36 mm SUV 14
2. Supraclavicular lymph node 19 X 20mm SUV 10
No other metabolic activity anywhere else. Nothing in Skin, breastbone or chest wall.
3. grade 1 invasive ductal carcinoma
4. ER +ve 80%, PR +ve 20% HER2 -ve
5. Ki-67 - 20%
6. Nothing reported in Chest Xray, Ultrasound of pelvis and Abdomen, liver
Please help me with some information on this.
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There are times when chemo response is very obvious by examination and in such cases, a PET may not be needed to assess response. And in some cases, we need it. Whether to do a PET or not, to assess chemo response, is a very individualized decision. It will vary from patient to patient and from doctor to doctor as well. We can not recommend here what to do next, or what is the status presently because the whole decision rests on clinical examination - what it was before starting chemo and what it is now. And also it depends on various other factors which is not feasible to describe here, as discussion is too long.
So my suggestion is, you must sit with your Oncologist and try to understand from him / her, how is the response to chemo, whether need for PET to assess post treatment response is there or not, what is happening to the Supra clavicular Node, etc.
A few reports can not dictate any treatment plan. It needs detailed assessment of the status of cancer, of general fitness of patient and so many other factors, to plan out; hence, opinion on reports shared here or email or WhatsApp is not possible at all.
Don’t worry, make a list of questions, request some time from your Oncologist and talk in detail. If not fully satisfied, you can always consider another opinion. And if you wish some online opinion sites from India, Tata Memorial Centre has one which is very good. You can try asking there.
Thank you very much Sumeet.
Does involvement of supraclavicular node worsens the prognosis? Does grade and ER/PR/HER2 result also matter? One of the website says If ER/PR is +ve and HER2 is -ve and if it is Grade 1, it is stage 3A.
When I run my fingers on it, it moves a lot. Also it's dimension is 19mm X 20mm which is not irregular. I have read the malignant tumors are normally hard, irregular and immovable. Could this be a false positive? Please let me know. How can we know conclusively, now that she has already completed 3 cycles of neoadjuvant Chemotherapy.
Even if this is positive, what are the chance that this could be removed surgically?
Is there any benefit of doing CT scan now to check the chemo response?
Also if we had an option of double mastectomy, what was the need of Neoadjuvant chemotherapy?
Also is there any benefit of doing Sentinel node biopsy at the time surgery since neoadjuvant chemotherapy has been done. There is a chance that the cancer would have got cleared from the nodes.
Also ,i have read that Grade 1 does not respond that well to chemotherapy. Is that true? Please let me know
Overall, my mom has been very active, she is not showing any fatigue or any illness whatsoever. I am very scared and anxious because of this breast cancer diagnosis. I am just not able to think of anything else now.
Apologies for several questions and Thanks a lot for your help
Your Oncologist would be appropriate to help you with all above queries. Each one of them will have an answer requiring 5 to 7 minutes to explain. And explanation to every single question will invite another 5 questions of doubt from your side. This is always a two way discussion. It takes about 30 to 45 minutes on intense discussion for me with my patients and relatives on all that you have asked. That’s why it is not feasible to discuss here. This forum can never replace your doctor. We encourage you to discuss all this with your doctor first.
I can very well understand your apprehension and anxiety. I would have felt same if I were in your place. Don’t worry. Again I repeat same, what you actually need is time from your Oncologist. Request him to sit and answer all your queries. You have all the right to ask each and every question. And just follow what your Oncologist says. Things will soon be fine.
Thanks a lot Sumeet. I will take Online opinion from TMC too. Thanks again!